Healthcare organizations and the federal government must come together to develop national standards for data collection and interchange across a seamless, secure electronic network if Americans truly want to improve patient safety and reduce the prevalence of medical errors, according to a new set of recommendations by the Institute of Medicine of the National Academies.
The IOM spells out its plan in "Patient Safety: Achieving a New Standard for Care," released online today. The report, the third major volume in the IOM series on healthcare quality that began with the groundbreaking 1999 tome "To Err Is Human," will be available in book form early next year.
The National Academies Press published the second installment, "Crossing the Quality Chasm," in 2001. In that book, the IOM called for a national IT infrastructure to improve patient safety.
In the latest report, an IOM committee of patient safety researchers maps out a vision of all healthcare organizations providing instant access to complete patient information and clinical decision support tools for clinicians and patients alike, as well as to capture information on patient safety, including data on near misses.
"Every day, tens if not hundreds of thousands of errors occur in the U.S. healthcare system," the report says, taking into account ambulatory and home care as well as hospital treatment. "The committee strongly believes that patient safety is indistinguishable from the delivery of quality care."
The IOM espouses creation of a "culture of safety" that encourages healthcare professionals, organizations and patients to take active roles in identifying potential and actual errors, taking steps to prevent or mitigate mistakes and reporting the information for educational purposes.
"For the first time, I think, in the history of literature, we've defined a culture of safety," says committee member Brent James, M.D., executive director of the Institute for Health Care Delivery Research at Intermountain Health Care in Salt Lake City.
The IOM also says that current patient safety programs do not pay enough attention to errors that do not result in adverse events.
"Near misses are important to improve processes," explains Drexel University surgeon John Clarke, M.D., a member of the IOM Committee on Data Standards for Patient Safety.
According to the IOM, various HHS agencies should take the lead in a public-private partnership in the development of data standards and in the creation of a secure platform for communication and exchange of patient data between various healthcare institutions.
"Establishing and maintaining data standards is integrally linked to the advancement and diffusion of clinical knowledge," the report says. The IOM asserts that the lack of comprehensive national standards actually inhibits private-sector investment in technology.
The IOM says Congress should provide direction, authority and funding for the establishment of national data standards. The IOM plan also asks Congress to authorize the Consolidated Health Informatics program between HHS, the Defense Department and the Department of Veterans Affairs, and for the National Committee on Vital and Health Statistics to identify appropriate data standards and any gaps in existing standards.
The federal government also should provide financial incentives for the private sector to invest in electronic medical records, the IOM says.
Under the proposal, the National Library of Medicine would be charged with disseminating clinical terminologies related to patient safety. Earlier this year, the NLM agreed to a five-year, $32.4 million contract to license the Snomed CT medical vocabulary from the College of American Pathologists for free usage nationwide, a step widely praised for removing a significant roadblock to connectivity.
The IOM estimates the entire plan will take 10 years to achieve.
"I think that it can be done in a decade," says committee member Ed Hammond, a retired informaticist from Duke University, Durham, N.C. "The biggest barrier to overcome is convincing people that it can be done, not only that it needs to be done."
David McCallie, M.D., vice president for medical informatics and chief scientist at clinical software vendor Cerner Corp., Kansas City, Mo., says the technology exists to make it happen.
"It's not a technology problem," McCallie says of the IOM plan. "The logistical, political and financial barriers are going to be harder to overcome."